Kokki Hannu
Department of Anaesthesiology and Intensive Care, Kuopio University Hospital, University of Eastern Finland, Kuopio, Finland.
Paediatr Anaesth. 2012 Jan;22(1):56-64. doi: 10.1111/j.1460-9592.2011.03693.x. Epub 2011 Sep 7.
Every anesthetist should have the expertise to perform lumbar puncture that is the prerequisite to induce spinal anesthesia. Spinal anesthesia is easy and effective technique: small amount of local anesthetic injected in the lumbar cerebrospinal fluid provides highly effective anesthesia, analgesia, and sympathetic and motor block in the lower part of the body. The main limitation of spinal anesthesia is a variable and relatively short duration of the block with a single-injection of local anesthetic. With appropriate use of adjuvant or combining spinal anesthesia with epidural anesthesia, the analgesic action can be controlled in case of early recovery of initial block or in patients with prolonged procedures. Contraindications are rare. Bleeding disorders and any major dysfunction in coagulation system are rare in children, but spinal anesthesia should not be used in children with local infection or increased intracranial pressure. Children with spinal anesthesia may develop the same adverse effects as has been reported in adults, but in contrast to adults, cardiovascular deterioration is uncommon in children even with high blocks. Most children having surgery with spinal anesthesia need sedation, and in these cases, close monitoring of sufficient respiratory function and protective airway reflexes is necessary. Postdural puncture headache and transient neurological symptoms have been reported also in pediatric patients, and thus, guardians should be provided instructions for follow-up and contact information if symptoms appear or persist after discharge. Epidural blood patch is effective treatment for prolonged, severe headache, and nonopioid analgesic is often sufficient for transient neurological symptoms.
每位麻醉医生都应具备进行腰椎穿刺的专业技能，这是实施脊髓麻醉的前提条件。脊髓麻醉是一种简便有效的技术：将少量局部麻醉药注入腰椎脑脊液中，可在身体下部提供高效的麻醉、镇痛以及交感神经和运动阻滞。脊髓麻醉的主要局限性在于单次注射局部麻醉药后，阻滞时间可变且相对较短。合理使用辅助药物或将脊髓麻醉与硬膜外麻醉相结合，在初始阻滞早期恢复或手术时间延长的患者中，可控制镇痛效果。禁忌证很少见。儿童出血性疾病和凝血系统的任何重大功能障碍很少见，但局部感染或颅内压升高的儿童不应使用脊髓麻醉。接受脊髓麻醉的儿童可能会出现与成人报告相同的不良反应，但与成人不同的是，即使是高位阻滞，儿童心血管功能恶化也不常见。大多数接受脊髓麻醉手术的儿童需要镇静，在这些情况下，密切监测充分的呼吸功能和保护性气道反射很有必要。小儿患者也有硬膜穿刺后头痛和短暂性神经症状的报道，因此，应向监护人提供出院后出现症状或症状持续时的随访指导和联系信息。硬膜外血贴是治疗持续性严重头痛的有效方法，非阿片类镇痛药通常足以缓解短暂性神经症状。
